I've been in really bad place lately. RSD, POTS, and numerous other autoimmune diseases aside, various life situations seem to be piling up on me in a bad way and I'm coming unglued a little (dying mother, putting a cherished pet to sleep, remarriage of ex-husband of 32 years to some girl 25 years younger than him...things like that).

I just had a huge dose one day outpatient infusion a couple of weeks ago; my second in the last two months. I was expecting the ketamine to reduce my depression since it can be used for that. It didn't. Come to think of it, I don't recall anybody here or on other RSD forums saying it did. Is it the dose perhaps? I think they do 10-20 mg for depression vs the 500 mg/four hours (a lot!) I got for RSD.

Anybody had relief from depression with standard RSD ketamine protocols, inpatient or outpatient? If so, what dose?

Denise

I have no information about ketamine, but I wanted to chime in to tell you that if you weren't depressed it would be surprising. I hope someone answers you about ketamine.

Hi CD,

Sorry to hear about all the stressors you have right now. That is a lot to deal with without any pain or health issues. I personally have not noticed much change in mood due to my low dose ketamine infusions. I have now had four of them ranging between 25 to 37.5 mg total. And although my mood is generally good these days, there is occasional lowness as one would expect when dealing with physical limitations. I wouldn't complain about an overall boost!

My mood was impacted by neurontin and that ultimately led to my switching to nortriptyline. Certainly neurontin doesn't affect everyone that way but it made a big dent in my mood.

What I found to be the most helpful was going to therapy. I ended up wishing I had gone sooner. I waited and waited thinking I would get better physically and Not need it. But even if I got 100% better it would not have negated the trauma and loss I suffered. Ultimately, a therapist specializing in chronic health and pain issues helped me move through a very dark time resulting from the changes CRPS brought to my life and gave me better coping skills. She was certified in EMDR and hypnosis and I found both of those modalities to be very helpful. I found her on the Psychology Today website by looking at special interests.

If you do not have outside support right now I strongly encourage you to seek it. A support group, therapist or clergy can help you carry your current burdens. There is no need to go it alone.

Sending hugs,

Hi Denise,

While Ketamine has mood elevating effects it is not a wonder AD in a couple of doses. I take it orally, 30-60mg 4 times a day and noticed slight improvement in my mood when I first started taking it for Neurological Hypersensitivity, unbelievable burning pain. I do have Depressive Personality Disorder so my mood is ALWAYS very low, but I still have somewhat of an elevation over and above what would be expected from the pain reduction.

Two things concern me about your Post, that at such a high dose are you experiencing side effects like hallucinations? When I push my dose up towards 100mg they become a problem.

Secondly, you have so many negatives in your life you need to seek proper medical help for your mood. Be it Therapy or a course of ADs, I do believe you need to talk to your GP about this before it becomes a deep rooted issue. Please do not try to rely on the side effects of a pain treatment.

Dave.

Thank you so much for your response. Because of the ketamine reducing my pain, I've gotten off the gabapentin (2400 mg/day). However, I think it might have actually been a mood enhancer for me. Not sure. And it did work well for me for the pain. Nevertheless, I don't miss the negative side effects. I'll deal with the reduced pain I have now without it.

It's very helpful for me to know the low dose ketamine you've been getting, similar to what they use for depression, has not affected your mood significantly. Perhaps it's not as effective for RSD patients as for patients with only or mostly depression issues.

I do take Effexor for neurogenic pain. It's the only drug I'm on now specifically for RSD. It's also a good antidepressant and it has helped with that as well. I also go to therapy. Twenty to 30 minutes of my neurofeedback sessions are with a licensed therapist to discuss feelings the neurofeedback is addressing or bringing out as my brain tries to normalize. I go to neurofeedback about three times a week on a regular schedule, so that's a good amount of therapy and the therapist is a good one for me. Due to some unavoidable circumstances, I haven't been able to have regular sessions over the last couple of months but I'm still going when I can. I'm on the schedule for three days next week. I can't describe the beneficial change in mood these treatments have brought me when I went regularly. It's expensive and insurance doesn't pay but it has been well worth it.

The entire reason for my question is because I had completed my sessions for the pain and mood centers of my brain and a second brain mapping showed improvement in the these areas at the time of the brain mapping. At this point I should only need boosters for this area since it has been "trained" and should pick up the more normal pathways with a little help now and then. How often we don't know. RSD affects the limbic centers of the brain so my mood and pain centers will continue to be affected negatively by the disease. I've had one booster and it showed we may need more frequent boosters than for someone with normal depression (not to minimize normal depression. It just may be different).

But back to the point of my original question. I also have POTS and it's out of control. My heart rate is shooting into dangerous zones upon standing. I'm dizzy and pass out frequently. I've done all the normal things with no relief. My rheumatologist wants me to travel to a center that specializes in treating POTS. POTS can be extremely refractory to treatment, as I have experienced. There's some scientific evidence that qEEG neurofeedback like I'm doing in those areas of the brain that control heart rate and blood pressure can help. So I want to do a full 30 sessions in that area first to see if it helps before I travel to yet more doctors. The problem is I'm now very depressed due to some life circumstances that would depress anybody, frankly. I was expecting and hoping that the ketamine I had a couple of weeks ago might help with the depression so I could proceed with the POTS treatments that I've already started instead of interrupting them by going back to the mood and pain centers of my brain, which would help my depression.

I can choose which areas I feel are most important when I go to my sessions. Unfortunately, it looks like I can't "cheat" by expecting the ketamine to help my depression so I'll have to suffer through more POTS disability before I can continue with those treatments. These treatments make you very tired since your brain has to work hard to reprogram so doing both areas at once or in seperate session on the same day is not an option.

Anyway, I hope this answers some questions, and perhaps even provides some information for others as I continue my journey of healing.

Thanks again,

Denise

Hi Dave,

Thanks so much for your response. My above reply to littlepaw might answer some of your concerns as to how I'm trying to deal with my depression and the reason for my question.

As for the high dose of ketamine. I realise that's a very high dose for a four hour infusion. The pain specialist I see is a world renown RSD doc and while ketamine isn't his thing, he's agreed to do it for me using his own protocol which is working for me. He believes it's easier on the body to really hit it hard for just the one day. I have a lot of problems so this may be very true for me. I'm grateful he'll even do it for me, considering, but I'm not a candidate for other treatment regimens he prefers.

They give me appropriate doses of ativan, zofran and toradol (sp?) during the treatment. So far hallucinations and nausea have been very well controlled. I do still have some problem with headaches but considering the protocol, it's a minor complaint.

Thanks again,

Denise